1/28. Moebius syndrome: the new finding of hypertrophy of the coronoid process.The first detailed description of congenital facial paralysis was reported by Moebius in 1888. It is characterized by either unilateral or bilateral paralysis of the facial muscles and an associated abducens palsy. The present report is of two patients with Moebius syndrome, who were also diagnosed with trismus at birth. Each patient also demonstrated bilateral hypertrophy of the coronoid process of the mandible. In effect, the zygoma obstructed the excursion of the mandible because of a "coronoid block." A three-dimensional computed tomography scan demonstrated normal temporomandibular joints but bilateral hypertrophy of the coronoid processes and micrognathia. Both patients demonstrated less than 10 mm of oral excursion. Bilateral coronoidectomies were performed through an intraoral approach. The oral excursions after surgery increased to at least 20 mm. In each of these patients, the coronoid process was enlarged relative to the zygoma, which was of normal size and configuration. The trismus was associated with blocking of the coronoid by the anterior zygoma, preventing open or full excursion of the hypoplastic mandibles. Moebius syndrome can have a variable presentation at birth. In two patients, the authors describe a new finding of hypertrophy of the coronoid process and trismus secondary to obstruction of the coronoid by the hypertrophic zygomas during oral excursions. Each patient is described, and a review of the literature is discussed.- - - - - - - - - - ranking = 1keywords = process (Clic here for more details about this article) |
2/28. tongue piercing. The new "rusty nail"?BACKGROUND: Cephalic tetanus is a rare form of the tetanus caused primarily by wounds or other infectious processes involving the head and neck. This condition frequently progresses to the generalized form of tetanus with the attendant risks and complications. methods: A case report of a young female who developed an unusual form of tetanus after a tongue piercing is presented here. We discuss this disorder as it applies to the contemporary caregiver with a focus on its presentation and recognition. RESULTS: A delay in diagnosis of 13 days from presentation occurred. The patient had a slow, uneventful but incomplete recovery course. She never developed significant airway compromise, nor did she demonstrate any evidence of hemodynamic instability but continued to have right facial weakness up to 6 months after discharge. CONCLUSIONS: A few factors were identified that contributed to the significant delay in diagnosis. The unusual nature of the disease and a lowered index of suspicion on the part of the initial caregivers were probably the major causes. Fortunately, no major adverse sequelae resulted from the delay. However, if this case heralds the onset of a rise in the incidence of tetanus, early recognition and diagnosis would seem essential to avoid much of the morbidity and mortality associated with the disease.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
3/28. Chronic dental infections mimicking temporomandibular disorders.BACKGROUND: trismus and jaw pain are not only caused by temporomandibular disorders (TMD), but also by various pathologies, namely infection, trauma, or neoplasms. TMD-like symptoms, as a result of the pathologies, may be confusing to a clinician. This paper reports two cases of chronic dental infection mimicking TMD. methods: Two patients were initially diagnosed with, and treated for, TMD. However the patients did not respond to the treatment. Limited range of motion and jaw pain were then clinically evaluated for differential diagnoses. Laboratory examinations and computerized tomography (CT) scans were carried out to disclose any underlying lesion. RESULTS: Laboratory examination, such as, c-reactive protein helped to detect latent infection. CT scans revealed insidious chronic dental infection imitating TMD. Surgical drainage and chemotherapy resolved the symptoms. CONCLUSION: The importance of a rational diagnostic process, including clinical and laboratory examinations and radiologic imaging, cannot be over-emphasized in elucidating true cause of the symptoms.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
4/28. trismus-pseudocamptodactyly syndrome: a case report.BACKGROUND: Hecht and Beals in 1969 described an autosomal dominant syndrome characterised by severe restriction of mouth opening, camptodactyly, shortness of leg muscles and, as a direct consequence, foot deformities. CASE REPORT: A case of a 4-year-old girl affected by this unusual syndrome is described. The patient underwent bilateral resection of coronoid processes by intraoral approach. An intraoral device was used in the immediate postoperative period in order to maintain mouth opening. Once at home, the patient has had, for six months, phisiokinesic therapy by means of a modified Darcissac device.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
5/28. Acute closed lock in a patient with lupus erythematosus: case review.collagen failure has been shown to result in synovitis, joint adhesions, and internal joint derangement. This case report illustrates the similarities between patients with systemic lupus erythematosus and an internally deranged temporomandibular joint and patients with internal derangement with no lupus erythematosus. If abnormalities in intra-articular collagen tissue lead to adhesion formation and restrict normal mobility during translatory movements, joint mechanics would be compromised. Arthritic changes, vasculitis, and synovitis of systemic lupus erythematosus appear to be contributory factors in this pathophysiologic process. Diagnostic and therapeutic arthroscopic surgery was performed. Acute and chronic signs of synovitis were observed during surgery, and tissue samples were obtained for histologic interpretation.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
6/28. osteoma of the condyle as the cause of limited-mouth opening: a case report.osteoma is a benign tumour consisting of mature bone tissue. It is an uncommon lesion that occurs mainly in the bones of the craniofacial complex. Only a few cases involving the condylar process have been reported. An osteoma of the left condyle causing limited mouth-opening in a 32-year-old Malaysian Chinese female is reported here to alert the practitioner to consider this lesion as a diagnostic possibility in instances of trismus or limited-mouth opening.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
7/28. Removal of a deeply impacted mandibular third molar through a sagittal split ramus osteotomy approach.We describe the case of a 48-year-old man who, after a 5-year history of recurrent infection and intermittent trismus associated with a deeply impacted lower right third molar tooth, presented to the accident and emergency department with severely limited mouth opening, extensive facial swelling and pyrexia. The lower right third molar was later removed successfully through a sagittal split ramus osteotomy approach. This case shows that the sagittal split osteotomy continues to have a valuable role in the removal of deeply impacted lower third molars, particularly when they are in close proximity to the inferior alveolar nerve.- - - - - - - - - - ranking = 0.7339487965938keywords = alveolar (Clic here for more details about this article) |
8/28. Congenital trismus secondary to masseteric fibrous bands: a 7-year follow-up report as an approach to management.A 7-year prospective follow-up report, which was previously presented in this journal as an initial pediatric case report, is presented as an approach to management of congenital trismus secondary to masseteric fibrous bands. Adams and Rees discussed management, including endoscopic exploration at 18 months of age with early recurrence of trismus. Under the care of the same plastic surgeon and his team, the progress of this patient over 7 years has given us an insight into management. The cause of trismus is not fully elucidated, but the condition can result in compromised caloric intake, speech development, facial appearance, dental care, and oral hygiene. The decreased oral opening may be secondary to shortening of the muscles of mastication, which may cause tension moulding and distortion of the coronoid process; yet, there is no consensus on the optimal management of temporomandibular joint trismus and all its causes. The patient presented in this report, now aged 7 years, has proceeded through to open surgery on two occasions yet, regrettably, has persistently tight masseter muscles and only 8 mm of jaw opening.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
9/28. A non-tooth-borne mouth-opening device for postoperative rehabilitation after surgical release of trismus.BACKGROUND: The treatment of severe trismus requires a combination of surgical release and postoperative rehabilitation; the latter is essential for preventing a relapse due to postoperative inactivity and scarring. mouth-opening devices for this purpose are placed between or fixed to the teeth to keep the dental arches apart; but patients suffering from severe trismus often present with partially or totally edentulous arches, decayed teeth, or periodontitis, which do not allow for the use of such devices. methods: In this article, a new mouth-opening device is described. It applies force to two intraoral screws placed in the vestibulum of the maxillary and mandibular bones. It can be used in patients with poor dental conditions and allows rehabilitation to start immediately after trismus release. RESULT: A case is presented. The interalveolar distance was improved from 5 mm to 45 mm and maintained at 6-month follow-up. CONCLUSION: Our non-tooth-borne mouth opening device is useful for postoperative rehabilitation after surgical release of trismus.- - - - - - - - - - ranking = 0.7339487965938keywords = alveolar (Clic here for more details about this article) |
10/28. Coronoidotomy as treatment for trismus due to jaw-closing oromandibular dystonia.Oromandibular dystonia is a focal dystonia involving the masticatory and/or tongue muscles. This report describes 2 female patients with jaw-closing dystonia treated by surgical resection of the coronoid process. The patients could not open their mouths due to involuntary jaw-closing muscle contraction. We first treated them by injecting lidocaine and alcohol (muscle afferent block) into the masseter and temporal muscles and then botulinum toxin. However, the trismus improved mildly and transitorily. Therefore, coronoidotomy was done under general anesthesia. The jaw opening increased to 50 mm. Coronoidotomy is useful for patients with jaw-closing dystonia in whom other therapies are ineffective.- - - - - - - - - - ranking = 0.125keywords = process (Clic here for more details about this article) |
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